Alvesco

Local side effects

Alvesco® is delivered in solution using a hydrofluoroalkane pressurized metered-dose inhaler (HFA pMDI). The resulting plume is soft, resulting in lower oropharyngeal deposition than that observed with HFA suspension pMDIs.
 
To see how a soft plume can help to reduce impaction in the oropharynx and subsequently the incidence of oropharyngeal adverse events,1 click here.

Compared with fluticasone propionate HFA pMDI, Alvesco® exhibits low deposition in the oropharynx (Figure 1).2 Alvesco® is also delivered as a prodrug,3 resulting in low steroid activity in the mouth and throat (Figure 2).1,2 This improved oral tolerability may contribute to better treatment adherence as well as a reduced need for patients to use a spacer and rinse their mouth following inhaler use.

231 fig 1Oropharyngeal deposition Richter 2005

Figure 1: Alvesco® oropharyngeal deposition is approximately half that of fluticasone propionate following inhalation from an HFA pMDI.
Adapted from Richter K, et al 2005.2

231 fig 2Local side effects Bateman 2008
Figure 2: Alvesco® is associated with a lower incidence of oropharyngeal side effects than fluticasone propionate over 6 months of treatment.1
Reproduced with permission from Elsevier.

References
  1. Bateman ED, Linnhof AE, Homik L, et al. Comparison of twice-daily inhaled ciclesonide and fluticasone propionate in patients with moderate-to-severe persistent asthma. Pulm Pharmacol Ther 2008;21:264-75.
  2. Richter K, Kanniess F, Biberger C, et al. Comparison of the oropharyngeal deposition of inhaled ciclesonide and fluticasone propionate in patients with asthma. J Clin Pharmacol 2005;45:146-52.
  3. Mutch E, Nave R, McCracken N, et al. The role of esterases in the metabolism of ciclesonide to desisobutyryl-ciclesonide in human tissue. Biochem Pharmacol 2007;73:1657-64.

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